The JTS established weekly patient management video teleconferences so that medical providers at all levels could review and discuss patients' treatments and outcomes in real time as they moved along the evacuation chain ( Blackbourne et al., 2012 Pruitt and Rasmussen, 2014). Gaps in communication were attributed to a multitude of factors, including the fast operational tempo, immature theater infrastructure, high casualty load, and limited prehospital data collection ( DHB, 2015 Eastridge et al., 2006 Rotondo et al., 2011).Īs the wars progressed, communication and the overall functioning of the care continuum improved in efficiency and efficacy, facilitated in the later years by the efforts of the Joint Trauma System (JTS). In the absence of effective information management systems, military providers would use a variety of improvised communication strategies, such as writing clinical information on patients' dressings ( Eastridge et al., 2006). In the early years of the wars in Afghanistan and Iraq, the military's continuum of care was particularly fragmented, with limited communication among the various roles of care (the roles of care are described in Chapter 2). With insufficient attention to patient centeredness, these transitions can be abrupt and disorganized, with too little communication among providers, the patients, and their family members at different levels of care. Transition points pose the greatest risk in terms of degradation in quality of care (e.g., treatment interruption, handoff errors) ( IOM, 2013a). Seamless Transitions Across the Continuum of CareĪs discussed in Chapter 2, a patient's journey from point of injury to rehabilitation and community reentry 1 is complex, involving numerous providers and multiple transitions between care settings. This chapter analyzes the extent to which military and civilian trauma systems have adopted a patient-centered approach, identifying gaps and opportunities to improve. Only a trauma care system structured around the patient experience, one that considers and actively engages the patient, family, and community, can achieve optimal short- and long-term outcomes for injured patients. These challenges are especially acute in the trauma setting, which is typically seen as a crisis environment characterized by loss of control and helplessness for patients and their support networks ( Hasse, 2013).Įven though trauma care is highly complex, particularly on the battlefield, patient-centeredness is an essential component of a learning trauma care system.

Patients, families, and communities are afforded only limited opportunities to engage in and shape their own care or to help in the design and functioning of a learning health system ( IOM, 2013a). Too often, patients face uncoordinated care and difficulties in navigating health care systems. For providers, a system's structure, incentives, and culture commonly are insufficiently aligned to support patient-centered care.

560)-has long been recognized as a core aim of a health care system however, patient-centered care is far from the norm ( Berwick, 2009 IOM, 2001, 2013a). Patient-centered care-defined as “the experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one's person, circumstances, and relationships in health care” ( Berwick, 2009, p. Responding to patients' needs and delivering optimal outcomes along the continuum of care demands a central focus on the patient.

Trauma center levels explained emt